Provincial health insurance plans (OHIP in Ontario, MSP in British Columbia, AHCIP in Alberta, etc.) cover medically necessary physician and hospital services, but there are significant gaps that affect most Canadians. Private health and dental insurance fills these gaps.

Typically covered by private plans: prescription drugs (often the largest expense for many families); dental care including preventive (cleanings, X-rays), basic restorative (fillings, extractions), and major restorative (crowns, bridges, dentures); vision care (eye exams, prescription glasses, contact lenses); paramedical services (physiotherapy, chiropractic care, massage therapy, psychology, naturopath, acupuncture); private or semi-private hospital rooms; medical equipment and supplies; and out-of-province emergency medical coverage.

Coverage levels, annual maximums, and the specific services covered vary significantly between plans and insurers. A basic plan may cover essential prescription drugs and preventive dental only; a comprehensive plan may include major dental, orthodontics, and higher paramedical maximums.

Premiums for individual health and dental insurance depend on your age, health history, the coverage level you choose (basic, enhanced, or comprehensive), and the insurer. As a general illustration, a healthy 40-year-old might pay a modest monthly premium for a basic plan covering essential prescription drugs and preventive dental, while a comprehensive plan with higher annual maximums, major dental, and broader paramedical coverage will cost more.

Premiums increase with age — a 55-year-old will typically pay more than a 35-year-old for the same coverage level. Pre-existing conditions may affect eligibility or result in exclusions for certain benefits.

For self-employed individuals and incorporated business owners, there may be tax-efficient ways to structure health and dental coverage — including Health Spending Accounts (HSAs) or Private Health Services Plans (PHSPs) — that can make the effective cost lower than the face premium. These structures are worth discussing with a tax advisor.

Individual health and dental insurance is medically underwritten — your health history may affect eligibility, premiums, or coverage. Some pre-existing conditions may be excluded from coverage (for example, a person with a history of back problems may have physiotherapy claims related to back conditions excluded), while others may be covered after a waiting period or at standard rates if the condition is well-controlled.

Some insurers offer guaranteed issue or simplified issue health and dental plans that do not require medical underwriting. These plans are available to anyone within a specified age range, regardless of health history, but typically have lower annual maximums and higher premiums per dollar of coverage than fully underwritten plans.

If you are transitioning from a group benefits plan (for example, leaving an employer), many insurers offer a conversion option that allows you to convert your group coverage to an individual plan without medical underwriting, provided you apply within a specified timeframe (usually 60 days of losing group coverage). This is one of the most valuable options available to people with pre-existing conditions.

Most individual health and dental insurance plans have waiting periods before certain dental benefits become available. Waiting periods are designed to prevent adverse selection — people purchasing coverage only when they know they need expensive dental work.

Typical waiting periods: basic dental (cleanings, X-rays, fillings, simple extractions) — 3 months; basic restorative (more complex fillings, root canals) — 3 to 6 months; major dental (crowns, bridges, dentures, implants) — 12 months; orthodontics — 24 months.

Prescription drug coverage typically has no waiting period. Paramedical services (physiotherapy, massage therapy, chiropractic) may have a 3-month waiting period on some plans.

If you are transitioning from a group benefits plan, some insurers offer a conversion option that waives waiting periods — provided you apply within the specified timeframe after losing group coverage. This is particularly valuable if you have upcoming dental work planned.

Individual health and dental insurance is portable — it stays with you regardless of your employment status. However, if you are currently covered under an employer group plan and are leaving your job, you have a time-sensitive decision to make.

Most group plans include a conversion option that allows you to convert your group coverage to an individual plan without medical underwriting, provided you apply within a specified timeframe — typically 31 to 60 days of losing group coverage. This is critically important if you have pre-existing conditions, because once the conversion window closes, you lose the right to convert without medical evidence and must apply for individual coverage through standard underwriting.

If you miss the conversion window, you can still apply for individual health and dental insurance, but it will be medically underwritten. Pre-existing conditions may be excluded or result in higher premiums.

Many individual health and dental insurance plans include vision care coverage, which typically covers eye exams, prescription glasses frames and lenses, and contact lenses up to an annual or biennial maximum. Some plans include coverage for laser eye surgery (LASIK or PRK), though this is less common and often subject to a lifetime maximum.

In Ontario, OHIP covers routine eye exams for children under 20 and adults 65 and older, but not for adults aged 20 to 64. For working-age adults, the cost of an eye exam and prescription eyewear is entirely out-of-pocket without private insurance or group benefits.

Vision coverage levels and maximums vary significantly between plans. A basic plan may provide $150 to $200 every two years for glasses or contacts; a comprehensive plan may provide $300 to $400 annually. If you wear glasses or contacts and do not have group benefits, vision coverage in an individual plan can provide meaningful savings.

Most individual health and dental insurance plans include paramedical coverage for services such as physiotherapy, chiropractic care, massage therapy, psychology, naturopath, and acupuncture, up to an annual maximum per practitioner type. The annual maximum is one of the most important variables to compare between plans.

For example, a basic plan might provide $300 per year for physiotherapy; a comprehensive plan might provide $750 or more. If you see a physiotherapist regularly for a chronic condition, the difference between a $300 and $750 annual maximum is significant.

In Ontario, OHIP does not cover physiotherapy for most adults (with limited exceptions for post-hospitalization care). The full cost of physiotherapy, massage therapy, and chiropractic care is out-of-pocket without private insurance or group benefits.

The tax treatment of private health and dental insurance premiums in Canada depends on how the plan is structured and your employment status.

For self-employed individuals: premiums paid for a Private Health Services Plan (PHSP) — a specific type of health insurance plan that meets the criteria under the Income Tax Act (Canada) — may be deductible as a business expense. A PHSP allows self-employed individuals to pay for eligible health and dental expenses with pre-tax dollars. Not all individual health and dental insurance plans qualify as PHSPs; the plan must meet specific criteria. Consult a tax advisor to determine whether your plan qualifies.

For employees: if you pay your own health and dental insurance premiums (not through an employer plan), you may be able to claim them as a medical expense tax credit on your personal tax return. The medical expense tax credit is a non-refundable credit that applies to eligible medical expenses above a threshold (the lesser of 3% of net income or a specified dollar amount, which is indexed annually).

For incorporated business owners: a Health Spending Account (HSA) or corporate-owned PHSP can allow the corporation to pay for health and dental expenses as a tax-deductible business expense, with the benefit received tax-free by the owner-employee.

Individual health insurance and a Health Spending Account (HSA) are two different tools for managing health and dental expenses, and they can be used together.

Individual health insurance provides coverage up to specified annual maximums for covered expenses. You pay a fixed monthly premium regardless of whether you use the coverage. It is most valuable for predictable, recurring expenses (prescription drugs, dental cleanings, paramedical services) and for protection against unexpected large expenses.

A Health Spending Account (HSA) — also called a Private Health Services Plan (PHSP) — is a tax-advantaged account that allows eligible individuals (typically incorporated business owners or self-employed individuals meeting specific criteria) to pay for eligible health and dental expenses with pre-tax dollars, up to a set annual limit. The corporation or business deducts the contributions as a business expense, and the employee-owner receives the benefit tax-free.

For incorporated business owners, an HSA can be a highly tax-efficient way to cover health expenses — effectively converting after-tax personal health spending into pre-tax business spending. HSAs and individual health insurance can be layered: use the HSA for expenses that fall below the insurance deductible or outside the covered categories, and use insurance for larger or recurring covered expenses.

Yes, Oracle RMS Insurance – London North is licensed by the Financial Services Regulatory Authority of Ontario (FSRA).

We operate through A Bajaj Financial Services Inc., which holds FSRA Insurance Act Licence No. 41867M in Ontario. Our licensing authorizes us to offer life and accident and sickness insurance products, including individual health and dental insurance, through our relationships with multiple Canadian insurance carriers.

As an independent insurance brokerage, we work with leading insurers. This allows us to compare available plans, benefits, and premiums to help individuals and families find coverage suited to their needs and budget.

Our goal is to make finding the right health and dental coverage simpler, with personalized guidance, access to multiple insurance providers, and support in understanding your options.